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General NPI Number Information
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NPI Number | 1811640790
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Entity Type | Organization
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Legal Business Name | CHATHAM ORAL SURGERY PC
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Dates
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Enumeration Date | 01/31/2022
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 1000 TOWNE CENTER BLVD STE 103
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City | POOLER
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State | GA
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Zip | 31322-4052
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Country | US
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Telephone | 912-354-1515
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Fax | 912-354-8181
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Provider Business Mailing Address
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Address Line | 501 EISENHOWER DR
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City | SAVANNAH
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State | GA
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Zip | 31406-2668
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Country | US
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Telephone | 912-354-1515
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Fax | 912-354-8181
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL C WILSON
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Credential | DMD
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Telephone | 912-354-1515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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